ASHCROFT LEADS
- Doctor: Dr Sudhir Krishnan & Dr Ramesh Mehay
- Nurse: Melanie Greenwood
- Admin:
DATE REVIEWED:
11th July 2019
DATE OF NEXT REVIEW:
July 2020
The Policy/Protocol
This page provides guidance for doctors, nurses and the admin team about how to handle blood tests and results. Whenever a doctor orders a test, it is normally done by the nurse or health care assistant. That sample then goes off to the laboratories, normally Bradford Royal or Leeds General Infrimary (and in some cased Airedale General).
Most blood, urine and faecal (poo) tests are usually back within 2 weeks. Other tests can take longer. So, if the patient has had several blood tests done, please don’t tell them to ring back within 5 days because only half the results will be back. It is far more productive to give the results when ALL OF THEM are back. There is a good 90% chance they will all be back by 2 weeks. So, tell patients to ring for bloods results in 2 weeks time – not any earlier.
Clearly, you don’t obey the 2 week rule if the blood test is marked urgent – like a D-dimer – in which case they are usually back after 48 hours (2 days). By the way, the results usually come back to us electronically down what we call pathlinks. Often, it will go to a specific doctors inbox – but the Health Care Assisstant can log in and allocate it to a different doctor (for example – when the doctor is on annual leave, or to distribute the results more evenly across all the docs).
A very interesting medico-legal case
A blood test came back showing a patient’s liver function had slightly gone off. The GP wrote a task message: “You’re liver tests are slightly derranged. This is nothing to worry about but please have the blood test repeated at your convenience”. The patient didn’t get the blood test done until too late – symptoms developed, he then came in and went into develop liver failure. He sued the GP successfully. Why?
- The GP did not use simple language (the patient did not know what the word derranged meant)
- The GP did not give any indication of how important it was to get this blood test done. In fact, you could argue that he wrongly reassure the patient. The patient felt “nothing to worry about” meant “nothing to worry about at all”. The GP could have written “don’t worry about this too much at this stage BUT it is important to get this test repeated within 2 weeks”.
- The GP did not give any indication of time frame – the GP in this case said – “at your convenience” and the patient said he thought that (along with “nothing to worry about”) meant there was indeed nothing to worry about. The GP could have written “come and have a repeat blood test within 2 weeks”.
Frequently Asked Questions (FAQs)
- Doctor documents during consultation in the new journal about blood test requirements
- Doctor should inform patient about any additional requirements for the blood test – e.g. fasting, morning sample for U&Es and clotting, etc.
- At Ashcroft, we recommend telling all patients NOT to eat a meat based meal in the 6 hours before the blood test (as this can affect eGFR results).
- If urgent bloods are required that day, it is the doctor’s responsibility to ask admin or a nurse to arrange this
- Doctor opens up pathology and radiology link and orders the blood tests directly from the ICE server, fills in the clinical indication and ticks the box to collect the sample later.
- If ICE is not working, please enter the blood request in the new journal.
- It is good practice to detail the clinical indication thoroughly
- If a doctor arranges an urgent test, it should be clearly documented in the notes and it is the requesting doctor’s responsibility to ensure that the results are acted upon e.g. D-dimer
- Doctors are required to file all blood results within 5 working days (this includes the weekdays you may not work)
- It would be good practice to at least glance at your results during every working day, because some significantly abnormal results requiring prompt action may arrive down the pathlinks
- It would also be considered good practice to read the new journal before filing results, so that you can check the indication and clinical circumstances and relate these to the result.
- In certain situations, it may be appropriate for a GP to reassign the results to the requesting GP. Please use your discretion
Abnormal results will be reported on by the doctor using the SystmOne tasks system. If a test result is normal and requires no further action, it will be ‘filed’. Admin staff will be able to see the ‘normal’ result filed within the patient’s record should they ring up and enquire. Some results will be abnormal and require specific action. For these sorts of results, the doctor will send an ‘action task’ to the ‘Admin Results’ group within SystmOne before filing the result. The action might be…
- To make an appointment with Doctor
- To make an appointment with Nurse
- Re-refer to new test or different test etc.
The admin member of staff will then contact the patient to implement this requested action. This process means that the practice takes pro-active action in contacting all patients who have ended up with an abnormal result, whilst implementing the requested doctor’s actions without the need for all patients to see the doctor again (and hence use up valuable doctor consultation time).
When filing results you usually have 4 situations:
- “Normal” results requiring no action
- File as “normal”, with “no action needed”
- It may be useful to leave a note in the comments box for the reception/admin team to inform the patient when they ring
- Just be careful with normal HBA1Cs in Diabetics who are on insulin – they could be having hypos – go into records and see if they need a review.
- Slightly abnormal results that you are not worried about (eg slightly low eGFR but stable for years)
- File as “satisfactory”, with “no action needed”
- Leave a note in the comments box, if you feel it would be helpful – e.g. “your thyroid blood tests are fine, repeat again in 6 months”, “you’re kidneys arent working as well as when you were younger. But this is normal and your kidney tests show yours is stable and nothing to worry about.”
- Slightly or Significantly abnormal results requiring routine action
- File as “abnormal”, with the appropriate action selected
- The doctor should aim to be proactive; task the “results” team to contact the patient with a message – e.g.“your blood tests show that your liver tests have slightly gone off. Nothing to worry about at this stage but it is important to get a repeat liver test in 2 weeks time”
- Make sure you include a time frame with any suggested action eg within 2 weeks, within 4 weeks, do not write “2-4 weeks – that is confusing – 2 weeks or 4 weeks? – how can a patient decide?
- If the admin team are unable to contact the patient about a routine task by telephone, a standard letter will be sent by post. If this is not appropriate, the doctor should mark the task as urgent with a red flag.
- It is good practice to write something in the new journal for good continuity of care
- Slightly or Significantly abnormal results requiring urgent action (e.g. results phoned through by the lab)
- File as “abnormal”, with the appropriate action selected
- It is the doctor’s responsibility to action these results immediately – you may need to call the patient directly yourself eg an anaemia of 6.5
- If you are unable to contact the patient, please speak to the admin team or the on-call doctor according to your discretion.
- Of course, you can task the “RESULTS” team and “red flag” the item – admin team always work on the red flag messages in their inbox before working on the routine. For example, red flag the following message “You’re blood tests shows that you have become anaemic. Please come and see the doctor within 1 week to assess you. This is important.”
- Please remember that our admin team are NOT clinical trained. They cannot second guess what you are thinking like other doctors can. So, don’t assume that.
- When writing a task, please write in the manner you wish the admin person to talk to the patient. For example: “Please tell the patient.. “your blood test shows that your liver tests are slightly abnormal. Hopefully, this is nothing to worry about but it is important to repeat the test in 2 weeks time. Please arrange to have this done”. Use patient-friendly language and don’t worry the patient unnecessarily. So, rather than saying “Your test is abnormal and the doctor wants to see you within the next 4 weeks” (which would panic the patient who will then demand an unnecessary on-the-day appointment), you might write ‘your cholesterol test is a little high, nothing to worry about at this stage but the doctor would like to see you again withiin the next 4 weeks to discuss further’. Do not use the word routine as in “make a routine appointment” – how are patients meant to know what routine is?
- Always put in a specific time frame as in the example above.
- Red flag tasks that are urgent.
- Remember – just writing in the blood test’s comments box and filing it DOES NOT MEAN it will be actioned. For it to be actioned, you must click the button that says generate a task from the comments box (which you can see near the comments box). Make sure that task goes to the “RESULTS” team.
- Doctors should clear their pathology inbox before going on leave
- If a doctor is on leave for 3 or more working days, the HCA keeps an eye on their inbox and will redistribute any results which arrive in their absence.
- When the nurse takes the blood tests, please speak with the requesting doctor/on-call doctor if:
- if it is not clear from the pathology request or the new journal about which bloods need taking
- if the patient has had recent bloods that may prevent the need for repeat bloods
- if the patient has requested additional bloods that weren’t originally requested by the GP. For example, PSA, lipids under age of 40, or any other unusual tests
- Patient instructions for getting results: nurse instructs or informs the patient that the results will be ready in 2 weeks and to contact the surgery in 2 weeks’ time and not earlier.
- Any urgent blood results (e.g. lab phones with an urgent result) – please note the blood results and write them down carefully in the patient’s medical record. Please then add the patients name and “urgent blood result from labs phone through – see notes” to the on-call doctor’s list.
- Other results will arrive down pathlinks, and most will go to the inbox of the requesting doctor However, it is the Health Care Assistant’s job to ensure blood results are allocated evenly amongst the doctors, irrespective of whether they work full time or part time (as all doctors get an admin session a week to look at their results). Please jiggle them about.
- Of course, the Health Care Assistant also needs to recognise when a doctor is away on leave and ensure their “bloods inbox” remains empty during the period they are away until the day of their return. If there are any that have “come down the line”, please reallocate.
- Any results arriving unallocated are forwarded to the appropriate doctor by the HCA
- GP trainees can be allocated blood results from week 3 onwards (of their starting date)
- If a doctor is not working for 3 or more consecutive working days, please reallocate their results to all other GPs equally
- Any routine monitoring blood tests (e.g. DMARD monitoring or annual CVD bloods) should be equally distributed among the GPs.
Routine tasks:
- When admin are processing patient messages in the ‘results’ task group they should try and contact them by phone at least twice at different times.
- If they are unable to get hold of the patient they should compose a letter by copying and pasting the doctor’s message.
- If it doesn’t seem appropriate to include the doctor’s message, admin can send a generic letter asking the patient to contact us regarding their results.
Urgent tasks (red flag):
- Remember – red flag tasks are urgent things – work on these before any of the others.
- Try to contact the patient by telephone within 2 working days
- If unable to contact the patient, please inform the GP who sent the task or the on-call GP, if the other GP is unavailable.
How to word what to say
- We understand you are not clinically trained. The GP should have clearly written a message in the comments box of the blood result if there is any action or the type of explanation they want you to give if a result is not normal. If this message is absent or not clear, do not second guess what the doctor is trying to say. Task them back or speak to them directly and ask them to read this page about how to write messages and comments for blood results (especially new and temporary staff like GP trainees and locums).
- If the doctor has left a comment, they should have worded it in a way that they want you to talk to the patient. For example: “Please tell the patient.. “your blood test shows that your liver tests are slightly abnormal. Hopefully, this is nothing to worry about but it is important to repeat the test in 2 weeks time. Please arrange to have this done”. Use patient-friendly language and don’t worry the patient unnecessarily. So, rather than saying “Your test is abnormal and the doctor wants to see you within the next 4 weeks” (which would panic the patient who will then demand an unnecessary on-the-day appointment), hopefully the doctor will have written something like ‘your cholesterol test is a little high, nothing to worry about at this stage but the doctor would like to see you again within the next 4 weeks to discuss further’.
- If a doctor has written something like a routine appointment – ask them for a time frame.
- Speak to the doctors who do not write good messages. Help us train them up.
If the result is not back
- Determine whether it has been 2 weeks since the test was done.
- If it less than 2 weeks, explain to the patient that results usually take 2 weeks to come back and therefore to ring again after this time.
- If it has been more than 2 weeks, explain to the patient that the result is not back from the labs. Apologise for the delay and that you will personally chase this up and get back to them within 24-48 hours. Ring the lab and chase the result. Once you’ve managed to get the result back, show it to a doctor (preferably the requesting doctor or the on-call doc) to get a professional interpretation of the result and what to say to the patient. Then, ring the patient back.
- Do not put any of these down for a telephone consultation/call with the requesting doctor nor the emergency on call doctor. Sort the problem out yourself first.
If the result is back AND has been reported on by a doctor
- Give the test result – try and use the words the doctor has written.
- If the interpretation is not clear – ask that doctor for clearer advice (rather than risk giving the patient the wrong information)
- Ask the patient if there were any other tests that were done
If the result is back BUT has not been reported on
- If it is less than 1 week since the test was back, advise the patient that the test is back but that the doctor will be shortly going through them. Advise them to ring again in 1 week and explain that this should give the doctor some time to report back on them.
- If it is more than 2 weeks since the test was done, apologise for the result not being reported on. Tell them that you will personally chase it up and get a doctor to take a look within 24h and get back to them.
- Get in touch with the doctor who is meant to have reported on the result – ask them for an interpretation. You can send a SystmOne Task to do this, although it is probably much easier and quicker to ask the doctor in person when they are at their computer screen. Alternatively, put it down as an extra on that doctor’s surgery screen if working that day with a patient telephone number for urgent on-the-day action. As a last resort, you may need to put it down for the emergency doctor’s list.
- Get the doctor to comment and ‘file’ the report within SystmOne.
- Then call the patient back and explain the result in layman’s terms.